Strict Immigration Rule Portends Another Kind of Public Health Emergency, Hospitals, Healthcare Groups Charge

While global public health officials grapple with how to screen international travelers for a spreading coronavirus and the 2019-2020 flu season has claimed the lives of 54 children so far in the United States, hospital groups, physician groups, and a coalition of businesses and others warned this week in court filings about another issue they say is a public health emergency: The Trump administration’s public charge rule.

Under the immigration policy change last year—which has been blocked by the 2nd US Circuit Court of Appeals from taking effect— the US will now take into consideration the use of certain government benefits by immigrants seeking a green card. These programs, including the Supplemental Nutrition Assistance Program, nonemergency Medicaid use by nonpregnant adults, and use of housing assistance programs, were previously excluded from consideration. While the previous rule primarily considered cash benefits at issue, the new rule would consider receipt of any public benefit at least once in a 3-year-period to weigh against the applicant.

In a filing with the Supreme Court, however, the administration asked the justices this week to intervene so that the rule can be implemented.

Last fall, an analysis documented the effect that the threat of a change in immigration policy was having on families in California, with providers and community organizations reporting worsening food insecurity, chronic illness, anxiety, depression, and other problems. Moreover, since the very idea of the rule was announced, there has been a chilling effect as the number of people, some US citizens, seeking care or health coverage, has dropped/

In the amicus briefs filed this week, the American Hospital Association, America’s Essential Hospitals, Association of American Medical Colleges, the Catholic Health Association of ihe United States, the Children’s Hospital Association, and the Federation of American Hospitals warn that the impact of those hurt by the change will not be limited, as the Department of Homeland Security has claimed. "The final percentage is expected to be anywhere between 15 and 35 percent of all immigrants, adding up to between 2.1 and 4.9 million individuals,"

The fear will keep nearly 7 million US children from receiving benefits to which they are entitled, with resulting “worse health outcomes, loss of prescription medication, increased rates of poverty and

housing instability, and impaired development," the filing says.

In additition, the hospitals say their institutions will be affected as well. "Coverage losses will lead to sicker immigrant populations and increased emergency-room visits, resulting in more unnecessary uncompensated care for hospitals and limiting hospital resources for expanding access to health care and other community services. Congress could not have intended these results."

In their own filing, the American Academy of Pediatrics, the American Medical Association, and other medical associations called the proposed DHS regulations “overbroad and unworkable.” For instance, an immigration officer could decide that an applicant has a “medical condition” that might lead them to become a public charge, but the term is undefined, they said. In addition, the rules will fall heavily on women and children, particularly pregnant women, due to the “totality of the circumstance” test, where an immigration officer will consider a variety of factors, with some weighted more heavily than others.

With no guidance as to how to make that decision, that will lead to likely discriminmation, the filing says.

“Under the totality of circumstances test, women may be penalized for being pregnant or for having given birth,” the brief states; that could worsen the country’s already poor maternal mortality and infant mortality statistics, or harm the cognitive and physicial development of millions of children.